|
BCE Saliva Confirmation 15-21
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$326.14 |
| Max. Negotiated Rate |
$612.35 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$399.36
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.69 |
| Max. Negotiated Rate |
$826.76 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Aetna Managed Medicare |
$206.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.49
|
| Rate for Payer: Anthem Medicare Advantage |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.69
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$206.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$206.69
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$206.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$206.69
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: NAPHCARE Commercial |
$310.03
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$432.64
|
| Rate for Payer: Quartz Medicare Advantage |
$206.69
|
| Rate for Payer: The Alliance Commercial |
$826.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.69
|
| Rate for Payer: United Healthcare PPO |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: Wellcare Medicare |
$206.69
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
BCE Saliva Confirmation 1-7
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$476.03 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$119.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Anthem Medicare Advantage |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.01
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$119.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$119.01
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$119.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$119.01
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$178.51
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$119.01
|
| Rate for Payer: The Alliance Commercial |
$476.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.01
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: Wellcare Medicare |
$119.01
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
BCE Saliva Confirmation 1-7
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$420.10 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$119.01
|
| Rate for Payer: Anthem Medicare Advantage |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.01
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.01
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.01
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$178.51
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$119.01
|
| Rate for Payer: The Alliance Commercial |
$327.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.01
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$208.26
|
|
|
BCE Saliva Confirmation 1-7
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
BCE Saliva Confirmation 22+
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
BCE Saliva Confirmation 22+
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$1,027.19 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$256.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.82
|
| Rate for Payer: Anthem Medicare Advantage |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.80
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$256.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$256.80
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$955.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$256.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$575.28
|
| Rate for Payer: Quartz Medicare Advantage |
$256.80
|
| Rate for Payer: The Alliance Commercial |
$1,027.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.80
|
| Rate for Payer: United Healthcare PPO |
$663.78
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: Wellcare Medicare |
$256.80
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
BCE Saliva Confirmation 22+
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$906.50 |
| Rate for Payer: Aetna Commercial |
$840.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$256.80
|
| Rate for Payer: Anthem Medicare Advantage |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.80
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$840.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$442.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.80
|
| Rate for Payer: Health EOS Commercial |
$805.39
|
| Rate for Payer: HFN Commercial |
$840.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$906.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$840.79
|
| Rate for Payer: Quartz Beloit One Network |
$389.42
|
| Rate for Payer: Quartz Commercial |
$504.47
|
| Rate for Payer: Quartz Medicare Advantage |
$256.80
|
| Rate for Payer: The Alliance Commercial |
$706.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.80
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$449.39
|
|
|
BCE Saliva Confirmation 5
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
BCE Saliva Confirmation 5
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$283.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$283.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$271.62
|
| Rate for Payer: HFN Commercial |
$283.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$283.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.33
|
| Rate for Payer: Quartz Commercial |
$170.13
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$255.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
BCE Saliva Confirmation 5
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: United Healthcare PPO |
$223.86
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
BCE Saliva Confirmation 8-14
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$574.87 |
| Rate for Payer: Aetna Commercial |
$420.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$162.85
|
| Rate for Payer: Anthem Medicare Advantage |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.85
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$420.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.85
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$420.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$574.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.85
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$244.28
|
| Rate for Payer: Preferred Network Access Commercial |
$420.89
|
| Rate for Payer: Quartz Beloit One Network |
$194.94
|
| Rate for Payer: Quartz Commercial |
$252.53
|
| Rate for Payer: Quartz Medicare Advantage |
$162.85
|
| Rate for Payer: The Alliance Commercial |
$447.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.85
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$284.99
|
|
|
BCE Saliva Confirmation 8-14
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
BCE Saliva Confirmation 8-14
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$651.41 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$162.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.66
|
| Rate for Payer: Anthem Medicare Advantage |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.85
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$162.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$162.85
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$162.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$162.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$162.85
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$244.28
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$162.85
|
| Rate for Payer: The Alliance Commercial |
$651.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.85
|
| Rate for Payer: United Healthcare PPO |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: Wellcare Medicare |
$162.85
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$991.68 |
| Max. Negotiated Rate |
$1,861.93 |
| Rate for Payer: Aetna Commercial |
$1,821.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.64
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,861.93
|
| Rate for Payer: Health EOS Commercial |
$1,801.22
|
| Rate for Payer: HFN Commercial |
$1,861.93
|
| Rate for Payer: Multiplan Commercial |
$1,619.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,861.93
|
| Rate for Payer: Quartz Beloit One Network |
$991.68
|
| Rate for Payer: Quartz Commercial |
$1,214.30
|
| Rate for Payer: WEA Trust Commercial |
$1,113.11
|
| Rate for Payer: WPS Commercial |
$1,499.00
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Professional
|
Both
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$472.25 |
| Max. Negotiated Rate |
$2,652.88 |
| Rate for Payer: Aetna Commercial |
$1,922.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.50
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,922.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$472.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,214.30
|
| Rate for Payer: Health EOS Commercial |
$1,841.69
|
| Rate for Payer: HFN Commercial |
$1,922.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,652.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,652.88
|
| Rate for Payer: Multiplan Commercial |
$1,619.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,922.65
|
| Rate for Payer: Quartz Beloit One Network |
$890.49
|
| Rate for Payer: Quartz Commercial |
$1,153.59
|
| Rate for Payer: The Alliance Commercial |
$1,011.92
|
| Rate for Payer: United Healthcare Medicaid |
$472.25
|
| Rate for Payer: WEA Trust Commercial |
$1,113.11
|
| Rate for Payer: WPS Commercial |
$1,499.00
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$964.82 |
| Max. Negotiated Rate |
$3,859.27 |
| Rate for Payer: Aetna Commercial |
$1,821.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.50
|
| Rate for Payer: Aetna Managed Medicare |
$964.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,315.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,011.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.44
|
| Rate for Payer: Anthem Medicare Advantage |
$964.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$964.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$964.82
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,861.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$964.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,132.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$964.82
|
| Rate for Payer: Health EOS Commercial |
$1,801.22
|
| Rate for Payer: HFN Commercial |
$1,861.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$964.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$964.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$964.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$964.82
|
| Rate for Payer: Multiplan Commercial |
$1,619.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,861.93
|
| Rate for Payer: Quartz Beloit One Network |
$991.68
|
| Rate for Payer: Quartz Commercial |
$1,315.50
|
| Rate for Payer: Quartz Medicare Advantage |
$964.82
|
| Rate for Payer: The Alliance Commercial |
$3,859.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$964.82
|
| Rate for Payer: WEA Trust Commercial |
$1,113.11
|
| Rate for Payer: Wellcare Medicare |
$964.82
|
| Rate for Payer: WPS Commercial |
$1,499.00
|
|
|
BCE US Biopsy of Thyroid
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
BCE US Biopsy of Thyroid
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
BCE US Biopsy of Thyroid
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.68 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.93
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$270.68
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: United Healthcare Medicaid |
$90.68
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
BCE US Breast Biopsy each additional LT
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$431.27 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$431.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.18
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$924.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$1,001.16
|
| Rate for Payer: Quartz Medicare Advantage |
$924.14
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
BCE US Breast Biopsy each additional LT
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
BCE US Breast Biopsy each additional LT
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,463.23 |
| Rate for Payer: Aetna Commercial |
$1,463.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,463.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$924.14
|
| Rate for Payer: Health EOS Commercial |
$1,401.62
|
| Rate for Payer: HFN Commercial |
$1,463.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.81
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.23
|
| Rate for Payer: Quartz Beloit One Network |
$677.71
|
| Rate for Payer: Quartz Commercial |
$877.94
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: United Healthcare Medicaid |
$62.21
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
BCE US Breast Biopsy each additional RT
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,463.23 |
| Rate for Payer: Aetna Commercial |
$1,463.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,463.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$924.14
|
| Rate for Payer: Health EOS Commercial |
$1,401.62
|
| Rate for Payer: HFN Commercial |
$1,463.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.81
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.23
|
| Rate for Payer: Quartz Beloit One Network |
$677.71
|
| Rate for Payer: Quartz Commercial |
$877.94
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: United Healthcare Medicaid |
$62.21
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
BCE US Breast Biopsy each additional RT
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
